MEDICARE: JOYCE'S NEW VISION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952774184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYCE'S NEW VISION LLC

Provider Business Mailing Address
First Line	:	1801 S 40TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-2607
Country	:	US
Telephone Number	:	913-789-9785
Fax Number	:	913-789-9785

Provider Business Practice Location Address
First Line	:	1801 S 40TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-2607
Country	:	US
Telephone Number	:	913-789-9785
Fax Number	:	913-789-9785

Authorized Official
Title or Position	:	OWNER
Name	:	JOYCE BUTLER
Credential	:
Telephone Number	:	913-789-9785

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	11/10/2015

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